Saturday, August 18, 2007

And she's back...

New FNP learned quite a bit while she was at her CME. However, the most striking thing that newFNP learned is that her patients will likely not benefit from a fucking shred of what they should be receiving.

For instance, the lovely and brilliant physician who lead the Obesity 2007 chat couldn't stress enough the importance of a nutritionist. Yes, indeed. However, let's just say that hiring a nutritionist is not on newFNP's clinic's short-list. Very low calorie diet? In newFNP's clinic, we call that 'food insecurity' as no one ever self-restricts to 800 kcal/day. NewFNP was thrilled to have it made public that a BMI of 26 has a positive effect on mortality. Ah, NHANES, God bless ya! NewFNP already knows that a little extra cushion is her natural set point, but she is stoked to know that science is getting on board with the voluptuous lady. Interestingly, this speaker did spend a fair amount of time on discussion of how fitness truly helps in preventing mortality. If your BMI is 31 but you are a walking-fool (45 minutes/day while talking), you're actually not in that bad of shape. However, if the only exercise you go is extending your left arm though your auto-roll-down car window to reach for your double bacon piece of shit burger, then - yes - you are on the train track to an MI.

And the fertility lecture. Fascinating, especially when newFNP has had two thirty-something friends struggle with it. Practical in newFNP's urban free health clinic? Uh, no. Interesting to learn that laying supine with the knees up for twenty post-coital minutes is advised if attempting pregnancy. NewFNP suspects that adopting such a position might lead to a 'round two' which goes against the tenet of QOD action for best baby-making.

NewFNP learned a lot about bisphosphonates. However, newFNP has succeeded in getting a single patient a bone mineral density scan. NewFNP would love to help the ladies spare the hip fracture - hell, who wouldn't! But newFNP is reluctant to just start adding Actonel to the water supply.

One great overall experience that newFNP had was to see that her practice was already mirroring a lot of what these experts were recommending. Hallelujah! And she is doing procedures which many of the physicians in attendance don't do, such as IUC (new phrase - apparently IUD is out of vogue) insertions. Why would anyone want to do less? Sure, newFNP would want to do fewer prostate exams but newFNP wishes that she could, for example, be doing biopsies for her patients. Because frankly, if newFNP's clinic isn't providing the care, it's unlikely that newFNP's patients will receive specialist care.

There are, however, things that newFNP would like to do more of, such as starting patients on insulin. However, newFNP's patients don't have glucose monitors so one shan't prescribe a hypoglycemic without appropriate monitoring! This conference recommended starting patients on insulin when they have an A1C greater than 8.5. Holy fuck - newFNP rarely sees a patient with an A1C that low, at least when they initiate care with us. A1C of 15.4, sure. Of 17.2 - rarely but not unheard of. When newFNP gets an A1c into single digits on oral hypoglycemics, she is quite thankful.

Mostly what newFNP learned is that she loves to take bike-rides through one of her state's most beautiful areas, amongst trees and rivers and a huge, glorious lake. NewFNP learned that perhaps her huge urban area is not where she will be for the rest of her life, that perhaps she will need a mid-point between the luxuries of urban life and the natural beauty which is too few and far between in her city.

No comments: